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Wills, Trusts& Probate What You

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10 Tips forCaregivers

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Ross & Shoalmire, LLP presents:

AGINGFREE

INSIGHT

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How Will You BeRemembered?

Reducing Stress thatComes with Aging

2017-2018 I Volume 1

www.AgingInsight.com 1

LEGAL MATTERS VA’s Aid & Attendance Benefit Will, Trusts & Probate - Do I Need Any of These - If So, What Do I Need? Special Plans for Special People Medicaid for Long Term Care - Answers to Common Questions

SENIOR HEALTH Reinventing the Home Health Wheel Lewy What? 10 Tips for Caregivers Reducing Stress that Comes with Aging

FINANCIAL FACTS How will you be Remembered? Transferring Values, Not Just Valuables by Engaging in Philanthropy Employment & Retirement Related Annuities

AGING INSIGHT RESOURCE DIRECTORYPresented by Ross & Shoalmire, LLP Elder Law Services Geriatric Behavioral Health Home Health Services Hospice Services Assisted Living Services Independent Living Skilled Nursing/Long-Term Care Rehabilitation Hospitals Sitter / Provider Services Directory of Local/National Services

John K. Ross, Lisa B. Shoalmire, Ross & Shoalmire, LLP and/or Aging Insight, LLC by way of this publication, are not offering legal advice. This publication is intended to be for informational purposes only. Before relying on any information contained in this publication, the reader should contact an elder law attorney. Aging Insight is a regis-tered trademark of Aging Insight LLC, all rights reserved.

2017-18 I Volume I

PublisherJohn K. Ross, IV Lisa B. Shoalmire

EditorChristal Browning

Sales and DistributionStacey Ford

Contributing WritersKelli Cook

Donna ButlerAnthony Fajardo, BSN, RN

John FordKristen J. Ishihara

Don W. KentKline Pillow Kyle PennyJohn Ross

Lisa Shoalmire

PrintMagna IV

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TABLE of CONTENTS

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John K. Ross IV is an Elder Law at-torney and senior partner of Ross & Shoalmire, LLP Elder Law Firm. John holds a degree in Accounting from Texas State University and a Juris Doc-torate from Texas Tech School of Law. John devotes his entire practice to as-sisting individuals with their estate planning and Elder Law needs. He is licensed to practice in Texas, Arkansas, and before the United States Tax Court. John is a U.S. Marine Corp veteran and is also an accredited Veterans A� airs attorney, a member of the National Academy of Elder Law Attorneys, and President of the Alzheimer’s Alliance. John is a frequent speaker on both a local and national level, and has been quoted by such national publications as the Wall Street Journal on aging issues. John is the co-host of the Aging Insight radio program Saturdays from Noon to 1:00 p.m on 98.5 FM Texarkana and the Aging Insight television program on KLFI-TV Channel 10 Texar-kana. You can also hear John on the Big Picture Retirement podcast.

Lisa Shoalmire, J.D., M.Tax, a senior partner of the Ross & Shoalmire, LLP Elder Law Firm, is a senior advocate and Elder Law attorney. Lisa’s practice is centered on protecting the rights of seniors and the disabled. She holds a Ju-ris Doctorate and a Masters of Taxation from Baylor University and a Certi� ed Public Accounting certi� cate from the State of Louisiana. Lisa is licensed to practice law in Texas and Arkansas and she is a member of the Board of Direc-tors for Opportunities, Inc. and the Tex-arkana Community Foundation. Lisa’s unique knowledge of the interaction between special needs planning, trusts, and asset protection planning has al-lowed her to assist countless families in maintaining the highest quality of life for themselves or their loved ones. Lisa is also a member of the National Academy of Elder Law Attorneys. Lisa is the co-host of the Aging Insight radio program Saturdays from Noon to 1:00 p.m. on 98.5 FM Texarkana and the Aging Insight television program on KLFI-TV Channel 10 Texarkana.

Welcome! Did you know that there will soon be over 75 million people over the age of 60 in the United States? We at Aging Insight are on a mission to empower our seniors to live their best lives yet! You are holding in your hands a pow-erful resource. Inside you will � nd vital information about how to stretch your resources in your retirement, how to obtain essential care for you or your loved ones and how to protect your legacy –in-cluding your life savings and your vulnerable heirs or ben-e� ciaries. We know you can accomplish these goals with knowledge and resources to guide you. You can � nd even more information at www.ag-inginsight.com.

We are passionate about our mission of empowering se-niors and we are deeply grate-ful to be a part of your life. Here is to your best life yet!

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1-877-653-0327 (TTY: 7-1-1). Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Restrictions and limitations may apply to all value-added services. © 2015 Cigna MCDTX_15_29862 05282015

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VA’s Aid and Attendance Benefi t

Bene! ts available through the Veterans Administration are the most commonly overlooked bene-! ts available to seniors. Many times, veterans and their spouses make in-correct assumptions related to their entitlement to VA bene! ts. � ese individuals will assume that since they did not retire from the military they are not entitled to any bene! ts from the VA, or the will assume that since they were not injured during their service they are not entitled to any bene! ts from the VA. While there are in fact bene! ts available to retired veterans and veterans with service connected disabilities, these are not the only bene! ts available.

� e most commonly overlooked VA bene! t is called the “Aid and Attendance” bene! t. Of the peo-ple who have heard of this bene! t, many have been incorrectly told that they do not qualify. � e re-ality is, this bene! t is available to many veterans and their spouses and can prove to be a lifesaver when times get tough.

In order to qualify for the VA Aid and Attendance bene! t, the veter-an must have served at least ninety (90) days of active duty. Of those ninety days, at least one of the days must have been during a desig-nated period of war. � is does not mean that the veteran had to have serve in combat. It is merely a re-

quirement that the veteran’s service occurred during one of the periods of time where the United States had declared war. O# cial periods of war include: the Mexican Border, May 9, 1916, to April 5, 1917; World War I, April 6, 1917, to November 11, 1918 (April 1, 1920, if served in Russia); World War II, December 7, 1941, to December 31, 1946; Kore-an Con% ict, June 27, 1950, to Janu-ary 31, 1955; Vietnam War, August 5, 1964, to May 7, 1975 (February 28, 1961, if served in Vietnam); and the Persian Gulf War, August 2, 1990 to unknown date.

In addition to the Veterans active duty service, he or she must have


been discharged from the military in some way other than dishonor-ably. � is could include an hon-orable discharge, an other than honorable discharge, a general discharge or a medical discharge. Even if a veteran was dishonorably discharged, it may still be possible to petition VA to have the dishon-orable discharge changed to one of the other forms of discharge.

A veteran who meets the above noted requirements is considered a wartime veteran. So what about the spouse of a wartime veteran? � e surviving spouse of a wartime vet-erans is also entitled to the Aid and Attendance bene� t, if he or she was married to the veteran for at least one year, married to the veteran at the time of the veteran’s death and has not since remarried. � ere is no requirement that the spouse be married to be veteran during the veteran’s time of service. Addition-ally, if the widow of a veteran does remarry and his or her new spouse is also a veteran who meets the eligi-bility requirements, then the spouse can qualify under that second mar-riage instead.

� e reason the VA bene� t is termed the Aid and Attendance bene� t, is because it is for veterans or their surviving spouses who need assis-tance with their normal activities of daily living. In order to meet this requirement, the applicant must be over sixty-� ve (65) years of age or blind or disabled and need some-one else’s help with their activities of daily living. Such a assistance might include help with feeding, bathing, getting dressed, meal preparation , � nancial management and similar items.

Finally, in order to qualify for this bene� t, the applicants must have

what the VA considers to be low monthly income and a normal net worth. However, a person should not assume that they do not meet these requirements without having a full understanding of what these terms mean. For example, when the VA uses the term “low monthly income,” they are referring to Income for VA Purposes (IVAP). IVAP is de� ned as the total household income minus any unreimbursed medical expenses. Such unreimbursed medical expens-es might include insurance premi-ums, copays, prescription drugs and the cost of in home care or assisted living. For example, a veteran with $4,000.00 in monthly income might not consider himself to have low monthly income. But if this veteran lives in an assisted living facility that charges $3,500.00 a month in rent, then the veteran’s Income for VA Purposes is only $500.00 per month. � at would meet the de� nition of low monthly income.

� e VA also requires an applicant to have a normal net worth. Unlike other federal programs, the VA does not de� ne normal net worth. In-stead, the VA will look at a person’s

net worth in relation to how much they are spending and their life expectancy. � erefore, a younger veteran might be entitled to keep more assets than an older veteran. Typically, the VA does not count the value of a home in its determi-nation of net worth. With a thor-ough understanding of the rules and the guidance of someone ex-perienced with dealing with the VA, many people can meet this section of the eligibility test.So, why is all of this discussion about the Aid and Attendance bene� t so important? For those who qualify, the VA will send money that the person can use to help pay for their care. A surviving spouse of a veteran could receive a maximum bene� t of approximate-ly $1,153.00 per month, a single veteran could receive a maximum bene� t of approximately $1,794.00 per month and a veteran with a dependent spouse could receive a maximum bene� t of approximate-ly $2,127.00 per month.

Let’s take Sally as an example. Sally is the surviving spouse of a veter-an who served during the Korean con# ict. She is seventy-nine years old and her Social Security and re-tirement income totals $2,000.00 per month. Sally’s health has de-clined and although she still lives at home, it is becoming more and more di% cult for her to take care of herself. Sally looked at one of the local assisted living facilities and really liked what she saw. How-ever, when she was told that the monthly cost would be $2,500.00, she assumed that she could not af-ford that much expense and con-tinued to live at home in an unsafe environment. But a& er applying for the Aid and Attendance bene" t through the VA. Sally was able


to receive the maximum VA bene� t of $1,153.00 per month. � is increased her income to $3,100.00 dol-lars and she can now a� ord to live in the assisted living facility that she thought she could not a� ord.

Planning related to obtaining VA bene� ts is very com-plicated. Not only must you meet VA’s eligibility rules exactly, this type of planning is only a small part of the type of planning on that is necessary for a person to protect themselves, their life savings, and their dignity. Many elder law attorneys are also accredited VA attor-neys. A lawyer must be accredited by the Veterans Ad-ministration in order to assist you with VA planning. In addition to elder law attorneys, there are Veterans Service Organizations (VSO) that can also provide as-sistance with VA bene� ts.

For those who qualify, the VA Aid and Attendance bene� t can be the di� erence between life and death. Anyone interested should seek advice, even if they do not need the bene� t yet. � ank you to all the veter-ans and their family who have given so much for this country.

John K. Ross IVElder Law AttorneyAccredited VA Attorney

United States Marine

John K. Ross IV, Lisa B. Shoalmire and/or Ross & Shoalmire, LLP, by way of this article, is not o� ering legal advice. � is article is intended to be for informational purposes only. Before relying on any informa-tion contained herein, the reader should con-sult an elder law attor-ney.

a couple started a fund

Starting a fund is and anyone can do it. You don’t have to be a millionaire.

You can create a charitable fund that puts your resources to great use ,

for the causes you . Learn more by contacting us today.

www.etcf.org

903-533-0208 Toll Free 1-866-533 ETCF (3823)

Simpli�ed Charitable Giving


When most people think of estate planning, they immediately think about to whom they are going to leave their money and possessions. Pass-ing down your assets to the next gen-eration shouldn’t be your only focus when you visit with a professional ad-visor to create an estate plan. Regard-less of your ! nancial situation, passing on your values, not just your valuables can result in a lasting and impactful legacy.

Passing the baton of your values to the next generation doesn’t just happen; it has to be cultivated during dinner conversations and long car rides, dur-ing vacations and daily chores. For families with strong moral, religious or civic beliefs, it may be particularly desirable for their children or grand-children to grown up to be caring, generous adults with similar, deeply held values. While we may not spend a great deal of time talking about our values, we know intuitively that our most important values are re" ected not by our words, but by our priori-ties and actions. Here are a few ways you can ensure the next generation receives what matters most.

1. Show and Tell and SupperOne of the most powerful ways to preserve your family’s legacy is to make sure that the next generation is aware of your family’s story. Understanding your family’s history will help future gen-erations know what is important and the skills, values, and char-acter traits that contributed to their ancestors’ success. Whether

it is a nightly supper or per-haps a holiday meal, family gatherings are a perfect time to reminisce about the peo-

ple and events that made you who you are today. # is type of everyday interaction can help reinforce what makes your fam-ily special; it can also help your children to develop the values you want them to have. Photos, historical relics or actual land-marks that you can show will help to reinforce the message. Telling your story is the most e$ ective way to communicate and transfer your values to the next generation.

2. Train the Next Generation to be GiversValues such as empathy, self-reliance and respect are easier to model than discuss. Getting children involved in philanthropy from an early age is an excellent way to demonstrate what mat-ters most to you. A simple act of generosity can instill in the youngest family members a greater appreciation for what they have, and yield bene! ts for years to come.


Take time to volunteer as a family at an animal shelter, participate in a park clean-up activity or serve at your local food bank. Another way to demonstrate what matters most to you is by creating a Donor-Advised fund that your family can use together to support local non-pro� ts. Your local community foundation can assist you in creating a Donor-Advised fund that is customized to meet your family’s spe-

ci� c giving objec-tives. A� er creating a Donor-Advised fund, you will re-ceive an immediate charitable deduc-tion a� ording you plenty of time to spend together as a family discussing the needs in your

community. � e family can then recommend grants to be made to nonpro� ts which are addressing those needs. Donors may designate family members as successor advisors to their Donor-Advised fund, allowing them the privilege to make grant recommendations both now and in the future. 3. Be Open to ChangeWhen the time comes for younger heirs to carry on the family’s phil-anthropic legacy, older family members need to be open to new ideas.

By challenging old approaches, and testing new mod-els, young philan-thropic leaders can exercise the values they learned from their elders. Sup-pose through your volunteer work at a food pantry, your

children learned the importance of nutrition and food stability. Your children may share your values but express it in their own way by creating and managing a community garden, raising fresh vegetables for those in need. � e end result is still feeding your neighbors, but the experience may be more ful� lling to your children because they planted, managed and harvested the food themselves.

Leaving a legacy is rarely just about money. For many of us, it means contributing to something meaningful and knowing we’re leaving the world a little better o� than we found it. � e best estate plans not only enable clients to pass their valu-ables to their heirs in a stra-tegic and tax-e% cient man-ner; they help instill values as well.

Kyle Penney President of East Texas

Communities Foundation

Guest columnist Kyle Penney is President of East Texas Communi-ties Foundation and a Chartered Advisor in Philanthropy. � e mis-sion of ETCF is to support philan-thropy by providing simple ways for donors to achieve their long-term charitable goals. To learn more about ETCF or to discuss your charitable giving, contact Kyle at 866-533-3823 or email questions or comments to [email protected]. More information is avail-able at www.etcf.org.


By: Anthony Fajardo As Americans age and live lon-ger, increasing numbers will live with multiple chronic condi-tions, such as diabetes or demen-tia, and functional impairments, such as di% culty in maintain-ing their home independence. One of the greatest healthcare challenges facing our country is ensuring that older Americans with serious chronic illness and other maladies of aging can re-main as independent as pos-sible. According to the Medicare Payment Advisory Commission (MedPAC), Medicare enroll-ment is projected to increase by more than 50% over the next 15 years from 54 million bene� cia-ries today to more than 80 mil-lion in 2030. Census projects that by 2030, the proportion of U.S. residents older than 65 will have nearly doubled from 2010. Why does it matter? Criteria for hospital admission and hospital stay has signi� cantly narrowed down and patients are being discharged to home much ear-lier. In addition, post-acute care facilities such as skilled nurs-ing facilities, long-term acute care, in-patient rehab, and nurs-ing homes have faced similar changes. Our love ones and our elderly population are poten-tially placed at risk in being sent home with a higher clinical need

than a conventional and traditional home healthcare are accustomed to. It is proven that the most dangerous time to a patient, especially the el-derly patient, is the � rst two to four weeks they are discharged from the hospital or facility. Solution from the industry. Rein-venting home health wheel involves implementation of evidence-base advanced practices, engaging and educating clinicians, e# ective utili-zation of technology, understand-ing healthcare economics, creating a proactive collaborative approach, and passion for clinical excellence in the home care arena. In essence, placing acute in post-acute care. $ erefore, embracing such innova-tive changes in the home health in-dustry o# ers that solution to acute care hospitals, post-acute care fa-cilities, and free-standing ERs when patients are ready to go home with and be with their love ones. In ad-dition, independent or ACO-based physician practices can bene" t with advance home health providers with preventing unplanned hospital ad-mission.

Solution for the patient. $ e goal is providing a better patient expe-rience and outcomes by ensuring that the patient receives appropri-ate, high-quality care regardless of

their setting and clinical acu-ity or needs. Additional bene" ts such as cost-e# ective healthcare, avoiding potential hospital-based complications, promoting inde-pendence and family involve-ment and education are attained with an innovative home health-care approach.

Healthcare is a dynamic and ev-er-changing phenomenon. To adequately and e! ciently meet the provisions of healthcare one should embrace and " nd ways to navigate through its changes. $ e Future of Home Health is the transformation of home health and home-based care to meet the needs of patients in the evolv-ing U.S. health care system. $ e spectrum of home-based care services could serve as an array of o# erings that are & exibly and seamlessly leveraged depending on patient need and preference.

Anthony Fajardo, BSN, RN, is the Execu-tive Clinical Director of Ally Home Health and has 25 plus year total nursing ex-perience in both acute care and home health industry. Co-founder of Ally Home Health an innovator in the home health industry.


By: Kline PillowUnbeknownst to many, a good solid estate plan requires more than just the signing of a Last Will and Testament. In fact, a simple Will is o! en times in-adequate if your wish is for a properly e" ective and e# cient distribution of your assets at the time of your death. While a good estate plan considers com-plex issues such as estate taxes, disability planning, protection for your surviving spouse and children and probate avoidance just to name a few, the key to truly understanding your plan is knowing the di" erence between probate and non-probate assets. While “Wills” and “probate” are commonly used and recognized estate planning terms, people o! en misunderstand what their actual functions are. $ e % rst step in understanding exactly how a Will works and when probate is necessary is to know what assets make up a probate estate. While you are living, all of the assets you own make up your estate. Assets that remain in your estate a! er your death must

pass through probate—the process through which a court determines how to distribute your property a! er you die. A Will, properly exe-cuted during your lifetime and sub-sequently approved by a court a! er your death, controls and directs the distribution of these probate assets. However, not all of your assets will be probate assets and your Will does not control how these non-probate assets are to be distributed.

Probate can be a complicated pro-cess that o! en includes the % ling of a Will and appointment of an execu-tor or administrator, court hearings, publication of notice, settlement of claims, % lings of inventory and ac-counting and distributing prop-erty to heirs. $ is process can also be time-consuming and expensive, which is why some people opt to avoid the probate process altogeth-er. However, to completely avoid probate, you must not die leaving behind any probate assets.

Probate assets are any assets owned solely by the decedent, with no bene% ciary designation and not held as joint tenants with rights of survivorship. $ ese as-sets that remain in the decedents name a! er their death must pass through the probate process and be distributed according to will or state or law. Some examples of common probate assets are as fol-lows:

• Your home or any other real es-tate property

• Banking accounts that are solely in the decedent’s name

• Life insurance policies that list the decedent or the estate as the bene% ciary

• Stocks, bonds or brokerage ac-counts that fail to designate a bene% ciary

Non-probate assets are assets that bypass the probate process and instead pass directly to the desig-nated bene% ciary or the surviving owner. Non-probate assets will generally be available


to your heirs sooner than if they had to pass through the probate process. Almost all assets can be made into non-probate assets. Some examples of common non-probate assets are as follows:

• Property that is owned joint-ly with your spouse or others through rights of survivorship

• Bank accounts you own solely in your name that have payable on death bene! ciaries listed

• Life insurance policies, IRA’s, 401(k) and annuities which are payable to a designated bene! -ciary

• Assets held in the name of a Trust or with a Trust named as the bene! ciary

When planning your estate, you need to have a clear understand-ing as to which assets are probate assets and which assets will not pass through probate. Your Will does not control or direct the dis-tribution of non-probate assets and sometimes that leads the un-intended distributions of your as-sets at death. It is important that your bene! ciary designations are updated to match your Will if

your desire is to have all of your as-sets distributed at your death as you provided in your Will. Alternatively, you may choose to eliminate the need for a Will and avoid the pro-bate process altogether by making all of your assets into non-probate assets and one of the best ways to do that is by establishing a Trust. While avoiding probate sounds ideal, sometimes non-probate assets can end up in the hands of some-one you did not intend to have or adversely a" ect the person who re-ceives the assets. # us, non-probate distribution should only be used a$ er understanding exactly who will inherit the asset when you die as well as the legal consequences of converting assets to non-probate as-sets for you during your lifetime and for the recipient of the asset at the time of your death.

When planning your estate, it is im-portant for you to know whether your assets will be probate assets or non-probate assets so that you can take the appropriate action to ac-complish your goals for distributing your property at the time of your death. Again, it is important that you contact an Elder Law and Estate

Kline Pillow is a practicing attorney in Tyler, TX. Born and raised in Texarka-na, he returned to the Ark-La Tex a� er graduating from Texas A & M Univer-sity School of Law where he practiced as an elder law attorney for over three years with Ross & Shoalmire—Kline re-cently opened the Ross & Shoalmire of-� ce in Tyler and has enjoyed serving the community in that capacity. Licensed to practice in Texas, Kline focuses in Long Term Care Planning, Trusts and Estate Planning, Guardianship and probate matters, and a variety of other services related to Elder Care.

Kline is a member of the State Bar Asso-ciation and is the former President of the Texarkana Young Lawyers Association. He is currently on the board of direc-tors for the Adult Protective Services in Smith County. Kline is an accredited Veterans A� airs Attorney, as well as a member of the National Academy of Elder Law

Attorneys.

Planning attorney to determine whether your property is be-ing distributed the way that you want and to properly consider the legal consequences of any ac-tion that you take when cra$ ing your estate plan.


On Friday, March 17, 2017, at the age of 64, I was diagnosed with Lewy body dementia (LBD) at the Mayo Clinic in Rochester, Minnesota. I had to ask “Louie What?” because I had never heard of it before. I learned that it is the second (or third depending on the source) most common form of neurodegenerative brain disease, behind Alzheimer’s. I had been experiencing various problems, including cognitive issues, for about eight months and had seen various doctors in Tyler and Dallas before be-ing referred to the Mayo Clin-ic. A! er four very busy days of evaluations, consultations and tests, they were able to make the diagnosis.

Initially, I felt a huge sense of relief - at least I knew what was wrong with me. Over the next several days and weeks, it began to sink in what I’m fac-ing - a progressive brain dis-ease which has no cure and no speci� c treatment. Although various “symptoms” can be treated, there is no treatment for the disease itself, or that slows down its progression. # e majority of patients di-agnosed with LBD survive

5-7 years, but life expectancy has ranged from as little as two years a$ er diagnosis to 20 years. # ere exists no accurate way to predict the rate of progression. Facing this disease, I have elected not to hide my diagnosis or cover it up. I in-tend to make the best of each day I am given, the best way I know how. Many friends and acquaintances have remarked that, if I hadn’t told them about my diagnosis, they wouldn’t even know I have it. I can assure you that I know it, and those closest to me (my wife of 42 years and my middle son who lives in the same town as we do) know I am not the same person I was just one year ago.

Here are a few of the things I am dealing with daily. First, I have wide % uctuations in my cognitive abilities from day to day. While every day seems mentally “cloudy” to me, some days are more like a dense fog where my mind oper-ates very slowly with unsure and unsteady results. My wife refers to these days as my “microwave fog” days - as I am unable to work the microwave. While I know I am supposed to push some buttons, I am unable cognitively to � gure out which buttons to push in what or-der. Other days are light fog days and I can function mentally fairly

well. # e worst days, howev-er, my mind feels like a black-board where everything has been erased. On those days, I can hardly function at all - I sit and stare o% with abso-lutely nothing working in my mind. I can carry on a con-versation - but only margin-ally. Secondly, I just am not the same person I was before. I � nd that, unlike my pre-dis-ease days, I am very apathetic about most things. Now, I have an extremely short at-tention span, and I have al-most no initiative. # is too, is all new to me.

Also, all my life, I have been a very low key person, very slow to get angry and mostly reserved. Now, however, I � nd I can have a very quick temper (which I now work to control) and I have exploded on friends, family and strang-ers, giving them a “piece of my mind” because of some perceived grievance. I now have to work to control these outbursts, which I recognize as totally uncalled for. # e result is that I don’t even feel like I am the same person I was before - and this distress-es me. Again, personality


change and mood disorders are known to be a part of LBD. But this is not all, I have experienced signi! -cant depression to the extent that on two occasions I have contemplated suicide. I now am taking anti-depressant medication. � ankfully, I have not had those feelings since.

Sleep problems are also an issue in this disease, and I touch all the bases here. One of the classic prob-lems in LBD is REM sleep behavior disorder wherein you physically act out your dreams while asleep. I started experiencing that condition about 20 years ago (which again, is common with this disease) and it still continues to a lesser extent. Restless leg syn-drome, periodic limb movements, sleep apnea and excessive daytime sleepiness can all be part of LBD and I experience all of them - one or more almost every day or night.

Finally, autonomic nerve dysfunction can be seen in LBD and I light up the scoreboard here. I experience lightheadedness/dizziness when I stand up (ortho-static hypotension) frequently. A fainting episode is what spurred my initial evaluation for my prob-lems and “loss of consciousness” is not unusual in LBD. I also experience unexplained sweating and/or coldness. (I have experienced both at di# erent times) which is a feature as well. At night, I o$ en

experience sudden muscle jerks and twitches which occur when I am in bed. All can be “symptoms” of LBD.

Since I experience any number of these “symptoms” on a daily basis, I am constantly reminded of my diagnosis. As I re% ect on these “symptoms” I am experiencing now, I can only imagine that they will seem trivial when compared to what is to come in the later stages of LBD. So, “Louie What?” has become for me Lewy body dementia and my journey has only just begun.

Don W. Kent

Don W. Kent is a shareholder in the ! rm of Kent, An-derson, Bush, Frost & Metcalf in Tyler, TX and has more than 34 years’ experience defending multi-million dollar products liability, toxic tort, business and medical liability claims against individuals and companies in state and fed-eral courts. Mr. Kent received his B.A. degree from Bay-lor University and his J.D. degree from the University of Houston. Don is Board Certi! ed in Personal Injury Trial Law by the Texas Board of Legal Specialization, is an “AV” rated attorney with Martindale Hubbell, and is a charter fellow of Litigation Counsel of America.

Don and his wife Cynthia have been married for 42 years and have three sons. Don enjoys gol! ng, hunting, scuba diving and baseball card collecting.


Seek support from other caregiv-ers. You are not alone! Whether it’s exchanging ideas and tips, � nding encouragement through the grief that can accompany the disease, or learning about valuable resources and partners -- a support group is an a# rming and safe place to share your journey. � e Alzheimer’s Al-liance of Smith County works with nine such support groups through-out Smith County.

Take care of your own health so that you can be strong enough to take care of your loved one. Visit your doctor regularly. Watch your diet, exercise and get plenty of rest. Making sure that you stay healthy will help you be a better caregiver. Remember, physical activity — in any form — can help reduce stress and improve overall well-being.

Accept o% ers of help and sug-gest speci� c things people can do to help you. Trying to do every-thing by yourself will leave you exhausted. Seek the support of family, friends and caregivers go-ing through similar experiences.

10 Tips for CaregiversEvaluate your needs, identify action steps and call the Alliance to connect with local programs and services that could provide support.

Learn how to communicate e% ectively with your loved one. As the disease progresses, new caregiving skills may be necessary. � e Alliance can provide strategies to help you better under-stand and cope with the behaviors and personality changes that o& en accom-pany Alzheimer’s.

Caregiving is hard work, so take re-spite breaks o& en. Make time for yourself. As a caregiver, it’s hard to � nd time for yourself, but staying con-nected to friends, family and activities that you love is important for your well-being. Even if it’s only 30 minutes a week, carve out a pocket of time just for yourself.

With generous private donations, as well as some public funding, the Al-liance is able to provide respite care grants to families and caregivers in Smith County. Options include in-home care and overnight breaks to ease the � nancial and emotional bur-den on caregivers, while ensuring their loved one is well cared for and safe.

Our “Terri� c Tuesdays” Day Club program provides a mid-week break for families and caregivers to recharge, relax, build relation-ships with friends, maintain their own health and personal care, and more! “Terri� c Tuesdays” meets each Tuesday from 10:00 a.m. to 2:00 p.m. in Tyler.

Watch out for signs of depression and don’t delay getting professional help when you need it. In partner-ship with the University of Texas at Tyler Memory Assessment and Research Center, counseling is available, through the Alliance, at no cost to families.

Be open to new technologies that can help you care for your loved one. Because wandering is such a common behavior in persons with dementia, anyone with Alzheim-er’s disease is at risk of wandering at any time, even if wandering or getting lost has not been a problem in the past.

Project Lifesaver is a program of-fered by the Alzheimer’s Alliance of Smith County in coordination with the Smith County Sheri% ’s O# ce and the Tyler Police Depart-ment. � e participant wears a wa-terproof transmitter bracelet that emits a radio signal unique to the wearer. If the person is reported wandering or missing, the device can be tracked by law enforcement.


Organize medical information so it’s up to date and easy to � nd and make sure legal documents are in order. � e Client Services Director at the Alliance can assist with evaluating and recommending the appropriate medical and legal information that you may need.

Become an educated caregiver. Knowledge can be empowering and encouraging on your journey with Alzheimer’s disease or a related de-mentia. � e Alzheimer’s Alliance o� ers educational workshops, semi-nars, and conferences throughout the year on topics such as compassionate communication, caregiver support, legal and � nancial planning and de-mentia 101.

Give yourself credit for doing the best you can in one of the toughest jobs there is! Our Client Services Direc-tor meets with persons who have Al-zheimer’s disease or other dementia types, their caregivers, family mem-bers and friends. Typically, people � rst contact the Alzheimer’s Alliance when memory loss is suspected, a re-ferral to a community service is need-ed, or guidance is needed in a speci� c situation. � e most helpful guidance begins early in the disease process!

Our Client Services Director is a Licensed Master Social Worker and is available to meet in person or by phone.

During your appointment, the Client Services Director will listen carefully to the concerns and issues presented and will help your family develop an individualized plan of action for navigating the de-mentia journey.

Ref: http://caregiveraction.org/resources/10-tips-family-caregivers


� e need for long-term care is explod-ing as our population ages. Just as the care need has dramatically increased, so have the costs. Long-term care ex-penses can easily exceed $60,000.00 an-nually for one individual. As a family, you watch what your parents worked to earn for a lifetime slowly dissolve into nothing.

If someone is paying for long-term care, they have three options: long-term care insurance, privately paying cash or Medicaid. We have found that only seven percent of our clients that need long-term care have long-term care insurance. Likewise, there are not many individuals that can privately pay expenses of $5,000.00 per month without taking a signi� cant hit to their retirement assets. � at leaves the third option of qualifying for Medicaid.

Long-term Care Medicaid is the only government program available to pay for skilled nursing home costs. To say that the rules and regulations sur-rounding Medicaid are complex is quite an understatement. Our � rm has been navigating this maze for years and still discovers new provisions and tech-niques on a weekly basis. But the pur-pose of this article is not to give you a detailed explanation of Medicaid but to tell you of the most important change

in Medicaid rule interpretation in a de-cade.

Medicaid determines eligibility for an individual by dividing their assets into countable resources and non-countable resources. � e non-countable resources have no e# ect on eligibility while the countable resources a% er a certain point prevent the person from receiving ben-e� ts. So, for example, a home worth up to $560,000.00 is a non-countable as-set while $25,000.00 in cash is a count-able asset. In its simplest terms, getting someone quali� ed for Medicaid is a matter of either spending the countable resources or converting the resources from countable to non-countable. In the example above, we need to “spend down” $25,000.00. � at could be spent by privately paying for care at the nurs-ing home or it could be used to make im-provements on the home, thus convert-ing countable cash into a non-countable asset. Why does this matter to you?

For the vast majority of Americans, the two largest personal assets a family owns are their home and their Individual Re-tirement Account (“IRA”). As discussed above, the home is a non-countable as-set. IRAs, or other retirement accounts, however, are generally countable.

Imagine a woman or man who is widowed, owns the home and has

$100,000.00 in his or her IRA. If this in-dividual needs long-term care, Medicaid will not pay for her until her countable assets are below $2,000.00. She would start making sizable withdrawals to cover the long term care costs and that IRA will deplete to nothing in under two years.

Similarly, imagine a husband and wife where one of them needs long-term care and they own a home, car and IRA worth $300,000.00. Medicaid would expect this family to deplete that IRA to $100,000.00 before they pay for the spouse in the facility. � e remaining spouse now has to live her last years on one third of the retirement she had planned on.

It no longer has to be this way. Due to a recent change in the interpretation of Texas Medicaid Policy, IRAs and other quali� ed accounts may be treated as either countable or non-countable sim-ply because of the investment struc-ture. Medicaid policy has a section on what they refer to as “Employment and Retirement Related Annuities.” In this section, it de� nes a Retirement Related Annuity as any type of annuity governed under Section 408(a), (b), (c), (k), (p) or (q) or under 408A of the Internal Rev-enue Code. � ese sections cover ANY annuity held in an IRA, SEP, SIMPLE or


Roth. More importantly, the rule clearly states that Retirement Related Annuities are NOT a countable asset for Medicaid eligibil-ity purposes. � is means that virtually any quali� ed annuity is no longer a countable asset for Medicaid under the new rules. So let’s look at our examples again. � at widower with a home and $100,000.00 IRA merely needs to purchase an annuity for $100,000.00 and that asset will not have to be spent before she quali� es for Medicaid. Likewise, the married couple with a home, car and $300,000.00 IRA need only purchase a $200,000.00 quali-� ed annuity and the spouse in the facility can qualify for Medicaid while the retirement assets are preserved for the spouse at home.

� e timing of the purchase of an annuity is critical, and if not done correctly and at the correct time may not have the intended re-sult. � erefore, implementation of this type of Medicaid planning should only be done on the advice of an elder law attorney that can advise you on the correct method and timing of implemen-tation. � e Elder Law attorneys of Ross & Shoalmire, LLP have been advising clients on long-term care asset protection and estate planning for years. We assist clients across Texas and Arkansas with Medicaid, Veteran Bene� ts, Wills and Trusts daily and have a dedicated team of elder law attorneys and Medicaid/VA case workers that can help guide you and your client on the right path to protecting your client’s resources.

Kristen is an elder law attorney with the � rm of Ross & Shoalmire. She is an accredited Veterans A� airs Attorney, a member of the National Association of Elder Law attorneys and licensed to practice in Texas, Oklahoma and Arkansas. Kris-ten graduated in the top of her class from Baylor Law, where she met her husband Richard. Kristen & Richard moved to Longview in 2006. � ey have two children – Lucas & Brianna, � ve and six years old.

Kristen Ishihara is humbled and honored to represent the citi-zens of Longview as the City Council Representative for District Four, having been elected in 2014.

Kristen and her family are members at Winter� eld United Methodist Church. Kristen has been actively involved in our community in a number of ways. She is the past President of the Zonta Club of Longview and currently serving as the President of the Junior League of Longview. Kristen is a mentor for Partners in Prevention, a coach for East Texas Lightnin’, the local Special Olympics team, and a board member for DORS Youth Transition Center.


Planning is Imperative

If someone with special needs de-pends on you to care for them, it is imperative that you plan for your disabled loved one if you cannot be their caregiver. One important piece of this plan is to consider cre-ating a Special Needs Trust to hold assets for the bene! t of the disabled individual. A special needs trust allows you to leave money for the care of your loved one that won’t disqualify them from Supplemen-tal Social Income (SSI) or govern-ment healthcare bene! ts such as Medicaid. � e government support programs for the disabled are an im-portant safety net for disabled per-sons and in many cases may be the only source for healthcare coverage. If a disabled person receives even a small inheritance or gi# outright, that person may immediately lose access to medical, housing and cash bene! ts until the assets are spent. � e disabled person then has to re-apply for these bene! ts which may take time to process.

Using Special Needs Trust to

Plan for the Disabled

Caregivers for people who are ill, aged or disabled are the unsung heroes among us. � ese caregivers are typically on the job 24 hours a day, seven days a week, caring for that special someone in their lives who has limitations which pre-vents that person from living in-dependently. � e subject of this care may be a child with Down’s Syndrome or it may be a spouse with Alzheimer’s disease. Either way, these caregivers stand as a bu$ er against the world to make sure that their special someone is provided with a safe, clean place to live, nutritious meals to eat, a ca-pable medical team to treat them, and love and a$ ection to enhance their lives. � e biggest fear these caregivers o# en have is a day when, due to their own death or disabil-ity, they cannot be there to care for their loved one.

However, if assets are set aside for the disabled person using a properly dra# ed and executed Special Needs Trust (SNT), then assets le# by the caregiver or others are not counted as a resource of the disabled person, but yet, these assets may be used to enhance the quality of life of the dis-abled person, beyond the very mod-est government programs available to them. Most importantly, assets held in a SNT do not disqualify the disabled person from their health coverage, housing bene! ts or dis-ability payments.

WHAT IS A TRUST

A trust is simply a legal entity that can hold assets for the bene! t of someone else. For instance, a par-ent may create a trust by signing a trust document creating a trust for the bene! t of a disabled child. � e trust document will name who the bene! ciary is (the disabled person) and the trust will also name a trust-ee, who is the person who can man-age the assets placed into the trust

and make disbursements to the bene� ciary.

TWO TYPES OF SPECIAL

NEEDS TRUST

� ere are two main types of SNTs: a First Party SNT and a � ird Party SNT. A � rst party SNT is funded using the bene� ciary’s own assets. A common example of this type of trust is a Court created trust for the disabled bene� ciary funded with money from a legal settlement from a personal injury lawsuit which was the cause of the indi-vidual’s disability. � e most common type of SNT is the � ird Party SNT. � is is a trust set up by third parties, such as par-ents of a disabled child. � e par-ents can create the trust today, even while they are living, or they can put a provision in the Last Will and Testament that creates the SNT at their death to hold assets for their disabled child.

An important distinction between the two types of trust is that, when the disabled bene� ciary dies, assets which remain in a First Party SNT must be paid over to the State that provided any government support to the individual during his or her lifetime. � is is called a “payback provision.” In contrast, any assets which remain in a � ird Party SNT at the disabled person’s death may be disbursed to other surviving family members or other named bene� ciaries. � ere is no payback requirement for a � ird Party SNT.

HOW TO SET UP A TRUST

A special needs trust is de� nitely not a do-it-yourself project. � ere are numerous federal and state laws, as well as administrative rules, which must be carefully fol-

lowed in setting up and running a SNT. A misstep, even an unknow-ing one, can cause the trust to be “busted”, and the assets drained out without bene� ting the disabled in-dividual. An attorney who special-izes in SNTs will know best how to create the trust for your individual circumstances and build in as much " exibility as allowed under the cur-rent laws and rules which a# ect SNTs.

FUNDING THE TRUST

If you are setting up a � ird Party SNT, you will need to estimate how much assistance the bene� ciary will need over their lifetime and deter-mine what the source of those funds may be, both while you are living and able to care for them, and a$ er you are deceased. � is may mean you name the trust as a bene� ciary of life insurance policies, retire-ment accounts or even place your residence in the trust for the bene� t of your disabled family member. If you create a � ird Party SNT while you are living, you can even encour-age other family members making gi$ s to the trust, either while they are living or through their own es-tate planning.

OPERATING THE TRUST

� e Trustee is responsible for man-aging the assets of the trust, � ling tax returns if required, and disburs-ing assets for the bene� t of disabled person. SNTs can be challenging to operate properly because of all the rules which have to be followed. Some family members are simply not equipped or are unwilling to learn to be a good trustee. Many who create a SNT appoint a profes-sional trustee, such as a bank trust o% cer, to be the trustee to make sure all the rules are followed and

the trust is not “busted”.

� e trustee makes sure that the as-sets in the trust are maintained and kept safe and that the needs of the bene� ciary are met. � e Trustee may use funds in the trust to pay for medical expenses not otherwise covered such as special medical equipment or in-home caregivers. � e trustee may also pay for qual-ity of life enhancements for the dis-abled individual such as cable tele-vision, tablet computers, vacations and entertainment.

PEACE OF MIND

By utilizing a SNT, caregivers get peace of mind that, even a$ er they are gone, their disabled loved one will have resources at their disposal to enhance their lives while still maintaining eligibility and medical bene� ts. You should speak to an Elder Law attorney about your situationif you are caring for a special needs person and create a plan of care.

Lisa ShoalmireElder Law Attorney

Accredited VA Attorney

Lisa Shoalmire, John Ross and/ or Ross & Shoalmire, LLP, by way of this article, is not o# ering legal advice. " is article is intended to be for informational purposes only. Be-fore relying on any information contained herein, the reader should consult an elder law attorney.

have resources at disposal to nce their lives e still maintaining

ibility and medical � ts. You ld speak to an r Law attorney t your situation

ou are caring special needs

on and create an of care.

Lisa Shoalmire



At each phase of life we experience di� erent types of stressors. Child-hood can involve academic stress, social demands, meeting parental expectations and possibly parental separations and divorce. " e teen-age years can involve the tumultuous emotional, academic, and social pres-sures of becoming a responsible and productive adult. Young adults face the challenge of juggling work and going to college, and for some doing this while raising children. Middle adulthood brings the stress of trying to balance work, family life, think-ing about retirement and taking care of elderly parents. In the retirement years comes a new realm of stressors, most have not encountered before and o# en in isolation. Seniors face numerous stressors at this phase of life. Most of the stress can be characterized by a “general sense of loss”. Some of the typical things they can face:

• � nancial hardship-surviving on less income, managing retirement funds

•physical decline-loss of mobility, loss of energy, increased pain, chronic dis-ease management

• loss of independence-driving, liv-ing alone, engaging in normal day to day tasks

• loss of loved ones and compan-ionship

• Increased health care cost and in-volvement

• Increased isolation or lack of sup-port from loved ones

• loss of cognitive functioning-memory loss, concentration issues

• caring for terminally ill spouse

• taking numerous medications-which can have negative side e� ects

• moving into a new home, nursing home, assisted living, or with chil-dren, or other relatives

Seniors o# en have a di% cult time asking others for help. Many feel embarrassment or shame, and will hide their struggles and need for support. At times they feel like a burden to their families. " e world around them has changed signi� -cantly and for some, they no longer feel safe. Living alone with limited cognitive and physical strength can put them at risk for being taken

advantage of, or even abused. Neglect can occur when seniors don’t have people in their lives that support them. Seniors have an increased risk for depression and anxiety. Some report a lost sense of purpose and meaning to life. During this phase, they can begin to review their life. " ey may � nd things that they are thankful for and can be proud of their contributions. " ey also can be unhappy about their choices, have regrets, re-member past hurts, losses, or can have traumatic memories resur-face that have been unprocessed and resolved.

" ere are many ways to reduce the e� ects of stress that seniors face. One of the main factors is to get connected and come out of isolation. One must realize the importance of connections and using coping skills that help to regulate the accumulating e� ects of the stressors they encounter. Over activation of our stress re-sponse system puts a person at risk for lower immune system functioning, anxiety, depression, gastrointestinal issues, increased

chronic pain, appetite disturbance and sleep disturbance.

It is important to learn healthy cop-ing skills to reduce the impact of stress on the body and mind.

Ways to combat senior stress:

1. Increase social connections and activities

• Find ways to connect with others. Join a church, a gym, or a local vol-unteer group.

• Ask for help from relatives or other friends on how to get more connect-ed

• Take a class and learn something new

2. Journaling

• Daily write down things that are stressful or upsetting.

• Make a gratitude list

3. Yoga, Tai Chi Meditation,

Walking or any form

of movement

• You can purchase DVD’s from Walmart

• � is helps to regulate stress in the body

• If you are smart phone savvy there are great mindfulness apps (mind-fulness daily)

4. Get a pet

•Pets are great company and emo-tional support

5. Volunteer

• Being part of team of helping oth-ers can reduce feelings of isolation

• Give you a purpose for your life

6. Breathing techniques

• Taking time to stop and doing dia-phragmatic or belly breathing.

• Breathe slowly in through your nose and out through your mouth completing multiplies sets. As you do the sets focus on your breathing can have dramatic e" ects on your stress and health

• Free App Breathe2Relax

7. Ask for help and support

• Don’t be afraid to talk with your Primary Care Provider

• Don’t be ashamed to let people know you need support

• Talk with your family, friends or Pastor

8. Increase your vitamin intake

• Eat lots of fruits and vegetables

• Get screened for vitamin de# cien-cies

9. Find a new hobby or activity

• Word searches, puzzles help in-crease brain function

• Read a novel

•Start # shing

•Start a card playing group

10. Laughter & Music

• Find ways to bring laughter back into your life

• Watch funny movies

• Call someone and tell them funny stories

• Listen to music that makes you happy and want to move…. And move!

11. Get in nature

• Small doses of sunlight

• Short walks admiring what you see

12. Get professional help

• It’s ok to seek the support from a professional trained to help you learn better coping skills

• It’s ok to get support to help pro-cess and resolve life’s hurts, losses and disappointments.

Don’t su" er in isolation. You can learn new ways to manage the stress of this di% cult phase in life. Let someone know today what you need and begin choosing some healthy coping skills that help you regulate reduce the impact of stress on your body and mind.

Kelli Cook is a Licensed Clinical So-cial Worker who specializes in Post-Traumatic Stress Disorder and Stress Management. She has been practicing psychotherapy for 18 years. Kelli is the Director of Genesis PrimeCare Hope & Recovery Center. Genesis PrimeCare Hope & Recovery Center is a trauma specialty outpatient counseling center in Texarkana that is part of a Federally Quali# ed Health Center. Kelli provides individual therapy, supervision of ther-apists, and seminars to the community in stress management, and trauma re-covery. She is passionate about seeing people heal from overwhelming and traumatic experiences and be healthier in all aspects of their life. ! e Hope & Recovery Center is located at 1400 Col-lege Drive, Texarkana, Texas


MEDICAID FOR LONG TERM CARE - ANSWERS TO COMMON QUESTIONS

Medicaid is a federally mandated pro-gram that provides payment for skilled nursing care for individuals who meet certain requirements. Although Medic-aid is a federally created program, the actual administration of that program is le! to the individual states. Because of this division between federally created rules and state administration, there are many speci" c di# erences between the states, although the overall rules are generally the same. Also, the rules change frequently, so from the time a reader starts this article, the rules may change before they even " nish the ar-ticle. As a result, the following infor-mation is for general knowledge and should not be relied upon without the advice of an expert in the " eld. $ is ar-ticle will be describing the quali" cations of the Medicaid program.

What are the requirements for qualifying for Medicaid for Long-Term Care Facility?

In order to qualify, a person must meet the following criteria:

(1)Be a U.S. Citizen or an alien lawfully living in the U.S. AND reside in the state where they are applying for bene" ts;

(2)Be over the age of 65, disabled or blind;

(3)Have gross monthly income of less than $2,205 (in 2017);

(4)Meet “medical necessity” require-ments for skilled nursing care;

(5)Meet certain asset requirements; and

(6)Live in a facility that accepts Med-icaid.

What is a “Medicaid bed”?

Only some facilities accept Medicaid as a way to pay for long term care. $ ese facilities typically only accept a lim-ited number of Medicaid recipients. A “Medicaid bed” refers to a bed in a semi-private room at a facility that accepts Medicaid and has fewer than their limited number of available spots.

If my spouse has to go to the nursing home, will I be required to pay all of their income to the nursing home?

Not always. Each state allows a Month-ly Maintenance Needs Allowance (MMNA) for the community spouse. $ e federally mandated minimum is $2,003.00 (in 2017) and the maximum

When it comes to Medicaid for long term care, we encounter many ques-tions. People encounter many rumors, misunderstandings and outright lies related to Medicaid. It is necessary for us to provide a general background to the program’s eligibility requirements before any discussion of planning can occur.

It is common for families to assume that they do not qualify for long term care Medicaid when in fact, they could. Even more commonly, families attempt to plan for their future long term care by acting on rumors and incorrect advice. $ e purpose of this article is to provide a general overview with the intent that once the reader is armed with the basic knowledge, he or she will not make the same mistakes as so many of the people who came before them.

What is the di! erence between Medicaid and Medicare?

Medicare is the federal health insurance program for people who are over the age of 65 or meet other speci" c criteria if they are younger. Medicare is broken down into Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Ad-vantage Plans, and Part D (prescription drug coverage). A monthly premium is paid for this coverage and is typically deducted from a person’s Social Security bene" t each month. Many times when a person enters into a Long Term Care facility, their stay is covered by Medicare for the " rst 20 days. Longer coverage can occur if supplemental insurance coverage is in place.

By: Donna Butler


is $3,023.00 (in 2017). � e MMNA di� ers from state to state. � is means that the community spouse is given an allowance up to the maximum amount allowed by their state of residency.

Does Medicaid count our total in-come towards the income cap?

No. Medicaid only counts the applicant’s income towards the income cap. � e cur-rent income cap is $2,205.00 (in 2017).

What if the applicant has too much income?

Even if the applicant has too much in-come, they can still qualify for Medic-aid. If the applicant otherwise quali! es for Medicaid long term nursing home bene! ts, the applicant (or the applicant’s spouse or duly appointed agent) may cre-ate a Quali! ed Income Trust or “Miller Trust.” � is trust allows the applicant to transfer his/her income into the trust and then qualify for Medicaid long term nursing home care bene! ts. � is means that no one should ever be disquali! ed for Medicaid because they have too much income! Either you have less than the in-come limit and qualify or you have more than the limit, set up a Miller Trust and then qualify. � is type of trust has very speci! c requirements and you should contact an expert for more details.

A Miller Trust is only used to overcome the income cap issue and is not a trust used to protect assets.

What assets can I keep and still qualify for Medicaid?

When applying for Medicaid, the state will look at what they call your “count-able resources.” To qualify for Medicaid, an unmarried individual’s countable re-sources cannot exceed $2,000.00. If both spouses are applying for long term care nursing home bene! ts, then their com-bined countable resources generally can-not exceed $3,000.00.

When a couple is married and only one of them is applying for long term care Medicaid, all available non-exempt re-

sources of both spouses will be counted as resources. One half of the couple’s re-sources will be set aside for the spouse not applying for Medicaid, with a mini-mum set aside amount of $24,180.00 and a maximum of $120,900.00 (in 2017). � ere may be ways in which to increase the maximum amount that can be set aside for the spouse staying at home but the strategies can be complex and should be discussed with an expert.

� e following is a more extensive list of exempt assets:

a. � e principal residence of the Appli-cant up to a value of $552,000.00;

b. A burial plot held for the Applicant or the Applicant’s family;

c. Term or burial insurance, if it has no cash value;

d. Identi! able burial funds in the amount of $1,500.00 or a prepaid irrevocable burial contract regardless of the value;

e. One automobile is exempt, regardless of value;

f. Household goods and personal items;

g. Life insurance policies owned by the Applicant with total face values of $1,500.00 per insured person or less;

h. Livestock and poultry that are held for business purposes or for consumption;

i. Business property essential for self-sup-port; and

j. Non-business property valued at up to $6,000.00, essential for self-support (gen-erally mineral interests).

Can’t I just give everything to my children or my church?

No. Any gi# made within a 5 year “look-back” period will incur a penalty. During the penalty period the applicant may be quali! ed for some limited Medicaid ben-e! ts but Medicaid will not pay for the nursing facility. Consult with an expert to discuss any gi# s before they are made.

Donna Butler is the senior Medicaid & VA Bene� ts para-legal for Ross & Shoalmire. She is a long time Texarkana resident and graduate of Texas High School. She is married to Marty and they have one daughter, Priscella, who is a re-cent graduate from the Univer-sity of Arkansas at Monticello. Donna holds an Associate Degree in Business Adminis-tration as well as a Bookkeep-ing Certi� cate from Texarkana College.

Donna is the secretary for the Texarkana Area Legal Assis-tants (TALA) group and an Event Lead for the American Cancer Society’s Relay for Life of Texarkana.

John K. Ross IV, Lisa B. Shoalmire, and Ross & Shoalmire, LLP, by way of this, is not o� ering legal advice. � is article is intended to be for informal purposes only. Before relying on any informa-tion contained herein, the reader should consult an elder law at-torney.


Elder Law Services

TYLER, TX Ross & Shoalmire, LLP 455 Rice Street, Ste. 102 Tyler, TX 75703 903-561-5653

LONGVIEW, TX Ross & Shoalmire, LLP 1125 Judson Road, Ste. 105 Longview, TX 75601 903-212-7313

PARIS, TX Ross & Shoalmire, LLP 1007 S. Collegiate Paris, TX 75460 903-905-4436

TEXARKANA, TX Ross & Shoalmire, LLP 1820 Galleria Oaks Texarkana, TX 75503 903-223-5653

Geriatric Behavioral Health Facilities

TYLER, TX UT Health Northeast 11937 US Hwy. 271 Tyler, TX 75708 903-531-4080ETMC Behavioral Health 4101 University Blvd. Tyler, TX 75701 903-266-2200

Home Health Services

TYLER, TX Ally Home Health 5430 Glen Lakes Dr. Tyler, TX 75703 903-749-0458Allegiance Home Health Services, LLC 401 E Front St., Ste. 120 Tyler, TX 75702 855-597-4663Angels Care Health Services 1820 Shiloh Rd., Ste. 1400 Tyler, TX 75703 903-561-2252At Home Healthcare 9846 TX Hwy. 31 Tyler, TX 75705 903-597-7700At Home Healthcare Tyler 419 S. Beckham Ave. Tyler, TX 75702 903-508-2485Balm In Gilead Home Health Services 4546 S. Broadway Ave., Ste. C Tyler, TX 75703 903-561-9419Beulah Home Health 3613 S. Broadway Ave., Ste. 401 Tyler, TX 75701 903-581-2058Choice Homecare 6760 Old Jacksonville Hwy., Ste. 101 Tyler, TX 75701 903-363-9932

Ross & Shoalmire “Legal Solutions for Senior Adults and Adult Children“



Home Health Services - Continued

CHRISTUS Trinity Mother Frances 3131 Troup Hwy. Tyler, TX 75701 903-510-7096Home HealthEncompass Home Health & Hospice 100 E. Ferguson St., Ste. 102 Tyler, TX 75702 866-592-9105ETMC Home Health 1409 S. Beckham Ave. Tyler, TX 75701 903-535-6051Girling Community Care 100 E. Ferguson St., Ste. 600 Tyler, TX 75702 903-526-2914Home Health LLC 417 S. Chilton Ave. Tyler, TX 75702 903-617-6872HomePointe Home Health P.O. Box 7838 Tyler, TX 75711 903-533-0300Interim HealthCare 1021 ESE Loop 323, Ste. 300 Tyler, TX 75703 877-205-7729Jordan Health Services 921 Shiloh Rd, Ste. B-200 Tyler, TX 75703 903-509-0959Kindred at Home 1700 SSE Loop 323, Ste. 110 Tyler, TX 75702 903-595-5266Maxim Healthcare Services 1828 ESE Loop 323, Ste. 101 Tyler, TX 75701 903-581-8881Paradigm Homecare LP 777 S. Broadway Ave. Tyler, TX 75701 903-581-1223Texas Home Health 7925 S. Broadway Ave., Ste. 900 Tyler, TX 75703 903-597-2086Unicare Home Health Services 3300 S. Broadway Ave., Ste. 208 Tyler, TX 75701 903-531-9949 JACKSONVILLE, TXA Pineywoods Home Health Care 1738 S. Jackson St. Jacksonville, TX 75766 903-589-0020Health Concepts Home Health Inc. 1623 S. Jackson St. Jacksonville, TX 75766 903-586-8847

HENDERSON, TXACEA Home Health 306 Shawnee Tr. Henderson, TX 75654 903-657-3475Advancing at Home Healthcare 702 Fair Park, Ste. 101 Henderson, TX 75654 903-657-6050Assist Care 100 Zeid Park, Ste. 101 Henderson, TX 75652 903-657-4413At Home Healthcare 506 Hwy 79 N. Henderson, TX 75652 903-657-1004

VAN, TX Health At Home Services 169 S. Oak St. Van, TX 75790 903-963-1300

ATHENS, TXJA Trinity Valley Home Health 300 S. Prairieville St. Athens, TX 75751 903-677-3500Caring Companions at Home 104 E. Corsicana St. Athens, TX 75751 903-677-3007Kindred at Home & Kindred Hospice 1750 Enterprise St., Ste. 100 Athens, TX 75751 903-675-5184Path" nders 311 S. Palestine St. Athens, TX 75751 903-677-8301Star Care LLP 214 W. Cayuga Dr. Athens, TX 75751 855-294-7284

Hospice Services

TYLER, TX CIMA 921 Shiloh Rd. Tyler, TX 75703 903-509-2462Compass Hospice 828 Fleischel St. Tyler, TX 75701 903-758-8383Encompass Home Health & Hospice 100 E. Ferguson St., Ste. 102 Tyler, TX 75702 866-592-9105Grace Hospice of East Texas LLC 1820 Shiloh Rd., Ste. 1103 Tyler, TX 75703 903-617-6893Harbor Hospice 727 E. Front St., Ste. 100-B Tyler, TX 75702 903-525-9390Heart to Heart Hospice 7925 S. Broadway Ave., Ste. 1140 Tyler, TX 75703 903-593-6619Hospice Plus 112 E. Line St., Ste. 202 Tyler, TX 75702 903-787-7502Legacy Hospice 1901 Rickety Ln. Tyler, TX 75703 903-509-3015National Hospice MedEquip 2227 Deerbrook Dr. Tyler, TX 75703 866-944-6463Hospice of East Texas 4111 University Blvd. Tyler, TX 75701 903-266-3400

Ross & Shoalmire “Free Initial Consultations“


Hospice Services-Continued JACKSONVILLE, TX Hospice of East Texas 217 E. Commerce St., Ste. E. Jacksonville, TX 75766 903-589-0232 HENDERSON, TX Angel Care Hospice 702 Fairpark Dr., Ste. 102 Henderson, TX 75654 903-657-2461Hospice of East Texas 114 Richardson Dr. Henderson, TX 75654 903-657-5593 ATHENS, TX Bristol Hospice 115 Heart Place Blvd., Ste. 100 Athens, TX 75751 903-670-1360Genesis Hospicecare 1317 S. Palestine St. Athens, TX 75751 903-675-4730Hospice Plus 627 S. Palestine St. Athens, TX 75751 903-292-1706Kindred at Home and Kindred Hospice 1750 Enterprise St., Ste. 100 Athens, TX 75751 903-675-5184

Assisted LivingTYLER, TX Atria Copeland 5317 New Copeland Rd. Tyler, TX 75703 903-218-4131Atria Willow Park 3500 S. Vine Ave. Tyler, TX 75701 903-561-4302Azalea Place Nursing and Rehab 810 S. Porter Ave. Tyler, TX 75701 903-593-2463Brookdale East 3505 University Blvd. Tyler TX 75701 903-565-0800Brookdale South 5403 Plantation Dr. Tyler, TX 75703 903-594-4201Garden Estates 2055 W. Grande Blvd. Tyler, TX 75703 903-534-0449Meadow Lake 16044 CR 165 Tyler, TX 75703 903-561-0657Oak Hills Terrace 2651 Elkton Tr. Tyler, TX 75703 903-747-3927Prestige Estates 6928 Paluxy Dr. Tyler, TX 75703 903-561-6102Reunion Inn 1515 Rice Rd. Tyler TX 75703 903-581-6100� e Hamptons 4250 Old Omen Rd. Tyler, TX 75707 903-566-8391� e Villa of Tyler 3323 Garden Valley Rd. Tyler, TX 75702 903-592-8852Waterton Inn 2885 Shiloh Rd. Tyler, TX 75703 903-939-9664 WHITEHOUSE, TX Oak Brook Health Care Center 107 Stacy Dr. Whitehouse, TX 75791 903-839-5050 HENDERSON, TX Arbor Place 1200 Kilgore Dr. Henderson, TX 75645 903-657-8620Azalea Place 1905 Old Nacogdoches Rd. Henderson, TX 75645 903-483-3076Brookdale Henderson 1000 Richardson St. Henderson, TX 75645 903-730-8962Henderson Health & Rehab 1010 W. Main St. Henderson, TX 75672 903-657-6513Autumn Leaves 321 Kilgore Dr. Henderson, TX 75652 903-657-1923 LINDALE, TX Wesley House 13923 FM 2710 Lindale, TX 75771 903-882-9296

MINEOLA, TX Autumn Wind 135 Autumn Wind Ct. Mineola, TX 75773 903-569-1111Mineola Healthcare Residence 716 Mimosa St. Mineola, TX 75773 903-569-5366 QUITMAN, TX Wesley House 1031 E. Goode St. Quitman, TX 75783 903-763-1303

Ross & Shoalmire “Estate Planning“



Assisted Living -Continued

JACKSONVILLE, TX Angelina House 211 Philip Ave. Jacksonville, TX 75766 903-589-1105Bonner Street Plaza 421 S. Bonner St. Jacksonville, TX 75766 903-586-9871Trinity Assisted Living 131 Zimmerman Dr. Jacksonville, TX 75766 903-284-6135 CANTON, TX Country Place Senior Living (Mulberry) 1835 S. Trade Days Blvd. Canton, TX 75103 903-567-2313Country Place Senior Living (Pine) 1833 S. Trade Days Blvd. Canton, TX 75103 903-675-6500 WILLS POINT, TX Free State Crestwood Nursing Home 1448 Houston St. Wills Point, TX 75169 903-873-4300& Assisted Living ATHENS, TX Arabella Athens 413 Gibson Rd. Athens, TX 75751 903-675-1995Country Place Senior Living 209 Wood St. Athens, TX 75751 903-567-2942CommunityGreen Oaks Nursing Center 500 Valle Vista Dr. Athens, TX 75751 903-677-3434Oak Wood Place 603 Wood St. Athens, TX 75751 903-675-2002

Independent Living

TYLER, TX Atria Copeland 5317 New Copeland Rd. Tyler, TX 75703 903-218-4131Atria Willow Park 3500 S. Vine Ave. Tyler, TX 75701 903-561-4302Garden Estates 205 W. Grande Blvd. Tyler, TX 75703 903-534-0449Meadow Lake 16044 CR 165 Tyler, TX 75703 903-561-0657Rosewood Estates 506 Rice Rd. Tyler, TX 75703 903-402-1261� e Hamptons 4250 Old Omen Rd. Tyler, TX 75707 903-566-8391� e Villas of Pine Ridge 3110 Towne Park Dr. Tyler, TX 75701 903-561-1461

Skilled Nursing/Long-Term CareTYLER, TX Azalea Place Nursing and Rehab 810 S. Porter Ave. Tyler, TX 75701 903-593-2463Azalea Trails 550 Old Jacksonville Hwy. Tyler, TX 75703 877-655-6183Briarcli" Health Center 3403 S. Vine Ave. Tyler, TX 75701 903-581-5714Brookdale East 3505 University Blvd. Tyler TX 75701 903-565-0800Brookdale South 5403 Plantation Dr. Tyler, TX 75703 903-594-4201Genesis at Clairmont 900 S. Baxter Ave. Tyler, TX 75701 903-597-8192Genesis at Colonial 930 S. Baxter Ave. Tyler, TX 75701 903-597-2068Greenbrier Nursing & Rehab 3526 W. Erwin St. Tyler, TX 75702 903-593-6441Park Place Nursing and Rehab 2450 E. 5th St. Tyler, TX 75701 903-592-6745Pinecrest Nursing and Rehab 3505 Old Jacksonville Hwy. Tyler, TX 75701 903-561-2011Providence Park 5505 New Copeland Rd. Tyler, TX 75703 903-939-2443Reunion Plaza Senior Care Center 1401 Rice Rd. Tyler, TX 75703 903-561-6060� e Heights 2650 Elkton Tr. Tyler, TX 75703 903-266-1841Tyler Continue Care 800 E. Dawson Tyler, TX 75701 903-531-4080Villa of Tyler 3323 Garden Valley Rd. Tyler, TX 75702 903-592-8852Waterton at Shiloh 2875 Shiloh Rd. Tyler, TX 75703 903-561-1300

Ross & Shoalmire “Advocacy for Seniors and People with Disabilities”


Skilled Nursing/Long-Term Care -Continued LINDALE, TX Colonial Nursing and Rehab 508 S. Pierce Lindale, TX 75771 903-882-1891Lindale Nursing Center 215 W. Margaret St. Lindale, TX 75771 903-882-7561 QUITMAN, TX Heritage Healthcare Residence 1026 E. Goode St. Quitman, TX 75783 903-763-2284 MINEOLA, TX Mineola Healthcare Residence 716 Mimosa Dr. Mineola, TX 75733 903-569-5366Wood Memorial 320 Greenville Ave Mineola, TX 75773 903-569-3852 JACKSONVILLE, TX Bonner Street Plaza 421 S. Bonner Jacksonville, TX 75766 903-586-9871Gardendale Rehab. & Nursing Center 1521 E. Rusk St. Jacksonville, TX 75766 903-586-3626Jacksonville Health Care Center 305 Bonita St. Jacksonville, TX 75766 903-586-3616Senior Care of Jacksonville 810 Bellaire Jacksonville, TX 75766 903-589-5300Twin Oaks Health & Rehab 1123 N. Bolton Jacksonville, TX 75766 903-586-9031 CANTON, TX Canton Healthcare Nursing & Rehab 1661 S. Bu� alo St. Canton, TX 75103 903-567-4135Canton Oaks 1901 S. Trade Days Blvd. Canton, TX 75103 903-567-3662 VAN, TX Van Healthcare 169 S. Oak St. Van, TX 75790 903-963-8641 GRAND SALINE, TX Anderson Nursing Care 520 Bradburn Rd. Grand Saline, TX 75141 903-962-4234Azalea Trails 416 Springcreek Rd. Grand Saline, TX 75140 903-962-4226Country Trails Nursing Center 1638 VZ CR 1803 Grand Saline, TX 75140 903-962-7595 WILLS POINT, TX Free State Crestwood Nursing Home 1448 Houston St. Wills Point, TX 75169 903-873-4300& Assisted Living ATHENS, TX Athens Healthcare and Rehab. Center 305 S. Palestine St. Athens, TX 75751 903-675-2046Green Oaks Nursing Center 500 Valle Vista Dr. Athens, TX 75751 903-677-3434Park Highland Nursing & Rehab. Center 711 Lucas Dr. Athens, TX 75751 903-675-8538South Place 150 Gibson Rd. Athens, TX 75751 903-292-4069

Rehabilitation Hospitals

TYLER, TX CHRISTUS Trinity Mother Francis 3131 Texas Hwy. 110 Tyler, TX 75701 903-561-1461Rehab / HealthSouth

MINEOLA, TX ETMC Rehabilitation Center 1220 N. Paci� c St., Ste. 1 Mineola, TX 75773 903-569-0842


Ross & Shoalmire “Legal Solutions for Senior Adults and Adult Children“


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Sitter/Provider ServicesTYLER, TX Caregivers Home Health 1901 Rickety Ln. Tyler, TX 75703 903-561-4455Caring Companions At Home 116 E. Heritage Dr., Ste. 104 Tyler, TX 75703 903-561-6483Comfort Keepers of Tyler, TX 120 S. Broadway Ave., Ste. 105 Tyler, TX 75702 903-509-4424Divine Health Care Services, Inc. 2737 S. Broadway Ave. Tyler, TX 75701 903-595-2400Exceptional Home Care 1420 WSW Loop 323 Tyler, TX 75701 903-533-0290Home Aid Care Givers 1530 SSW Loop 323 Tyler, TX 75701 903-533-1300Home Instead Senior Care 4500 S. Broadway Ave., Ste. 106 Tyler, TX 75701 903-258-9061Kindred at Home 1700 SSE Loop 323, Ste. 110 Tyler, TX 75702 903-595-5266Outreach Helath Services 3110 Golden Rd. Tyler, TX 75701 903-405-7772Right at Home 420 E. 5th St. Tyler, TX 75701 903-253-0778Unicare Home Health Services 3300 S. Broadway Ave., Ste. 208 Tyler, TX 75701 903-531-9949Visiting Angels 419 W. Houston St. Tyler, TX 75702 903-581-5122 JACKSONVILLE, TX Grace Visiting Nurses 111 Cash St. Jacksonville, TX 75766 903-617-6835Home Instead Senior Care 402 S. Ragsdale St. Jacksonville, TX 75766 903-284-6102 ATHENS, TX Caring Companions at Home 104 E. Corsicana St. Athens, TX 75751 903-677-3007Genesis Extra Care 1317 S. Palestine St. Athens, TX 75751 903-286-9081

Ross & Shoalmire “Free Initial Consultations“

Ross & Shoalmire “Long Term Care Medicaid Planning“

ADULT PROTECTIVE SERVICES

Smith County APS302 E. Rieck RdTyler, TX 75703(P) 903-561-5359

ALZHEIMER’S ALLIANCE

Alzheimer’s Alliance211 Winchester Dr.Tyler, TX 75701(P) 903-509-8323

AREA AGENCY ON AGING

Area Agency on Aging3800 Stone RoadKilgore, TX 75662(P) 903-218-6400

MEDICAID

Texas Medicaidhttps://www.yourtexasbene! ts.com (P) 877-541-7905

Medicare.govCenters for Medicare & Medicaid Services7500 Security Blvd., Baltimore, MD 21244-1850www.medicare.gov(P) 800-MEDICARE

MEDICARE

Center for Medicare Advocacy PO Box 350, Willimantic, CT 06226http://www.medicareadvocacy.org/ (P) 860-456-7790 (F) 860-456-2614

VA SERVICES

Smith County Veteran’s Services210 E. FergusonTyler, TX 75702(P) 903-590-2950

Ross & ShoalmireCerti! ed VA AttorneysHelping with the Aid & Attendance Bene! t(P) 1-800-780-6993

SUICIDE LIFELINE

National Suicide PreventionLifeline(P) 1-800-273-8255

Directory of National Services/Local Resources


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